Ventricular Overdrive Maneuver

From Ask Dr Wiki

• Manuever to Atypical AVNRT vs ORT with septal pathway

How to Perform

• Pace the Right Ventricle at CL 10-40 msec shorter than tachycardia cycle length
• If there is no acceleration of the atrial rate this may be due to
  • Termination of the tachycardia (This argues against Atrial Tachycardia)
  • VA block
• If there is entrainment then look at the activation pattern to make sure that it is the same activation pattern and look for the AV response
• Calculate PPI-tachycardia cycle length for long RP and short RP tachycardias with concentric activation
  • If PPI - TCL > 115 then Atypical AVNRT (range 140 - 260)
  • PPI - TCL < 115 then it is orthodromic reentrant tachycardia with a septal BT (range 0 - 95)